Study: Early surgery outperforms endoscopy for long-term pancreatitis

Editor's Note

Early surgical intervention should be prioritized over endoscopy-first treatment in managing chronic pancreatitis with dilated pancreatic ducts, according to the results of a follow-up study of the ESCAPE randomized clinical trial.

Published November 20 in JAMA Surgery, the findings specifically highlight pain relief, patient satisfaction, and need for follow-up intervention over a mean follow-up period of 8 years. The research involved 88 patients randomized across 30 Dutch hospitals between 2011 and 2018 and assigned to either early surgery or endoscopy-first treatment. The primary outcome was pain, measured using the Izbicki pain score. Secondary outcomes included patient-reported pain relief, satisfaction, and quality of life. Key findings include:

• At the end of follow-up, early surgery yielded a lower mean Izbicki pain score (33 vs. 51) compared to the endoscopy-first group.
• Complete pain relief was achieved by 45% of patients in the early surgery group versus 20% in the endoscopy-first group.
• A higher proportion of patients undergoing early surgery were “very satisfied” with their treatment (71% vs. 33%) and more likely to recommend it to others (87% vs. 47%).
• Early surgery reduced the need for reinterventions (26% vs. 44%). Patients in the endoscopy-first group required an average of four procedures, compared to one in the early surgery group.
• Patients who progressed from endoscopy to surgery had worse outcomes than those initially treated with early surgery, with higher pain scores and less complete pain relief (12% vs. 55%).
• Achieving endoscopic ductal clearance did not improve long-term outcomes.

These results underscore the limited benefits of endoscopic ductal clearance and reaffirm early surgery as the optimal strategy for long-term pain management in chronic pancreatitis with dilated pancreatic ducts, researchers write. Early surgical intervention also reduced the procedural burden and complication rates compared to endoscopy-first treatment.